2022-11-09T20:05:14-06:00 2021-12-31 MILLER KAPLAN ARASE LLP 4123 LANKERSHIM BLVD NORTH HOLLYWOOD CA 916022828 990 2021-01-01 010757287 UFCW-HAWAII FOOD EMPLOYERS HEALTH AND WELFARE TRUST FUND % HAWAII BENEFIT ADMIN INC UFCW 8088417575 200 N VINEYARD BLVD STE 100 HONOLULU HI 96817 PATRICK LOO trustee 8088417575 2022-11-07 true PATRICK LOO 999009999 Kami B Cohen P00642929 8187692010 3 2021 2022-09-23 18:48:47Z FRANK JORGENSENPATRICK K LOO 200 N VINEYARD BLVD STE 100 HONOLULU HI 96817 24435812 false X N/A X 2002 HI SEE SCHEDULE O 4 4 0 0 0 0 0 0 19666688 20484590 87635 77116 0 0 19754323 20561706 0 0 14839269 14956018 0 0 0 0 0 982543 1034443 15821812 15990461 3932511 4571245 11514989 15360844 4388068 3736761 7126921 11624083 X SEE SCHEDULE O false false SEE SCHEDULE O false false false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false false false false false false false false true false false true 2 0 false 0 true false false false false false false false false X 4 4 false true false false false false false true false false false true true true true true true false false false X HAWAII BENEFIT ADMIN INC 8088417575 200 N VINEYARD BLVD 100 HONOLULU HI 96817 PATRICK K LOO LABOR TRUSTEE 1.0 0.0 X 0 0 0 GWEN RULONA LABOR TRUSTEE 1.0 0.0 X 0 0 0 FRANK JORGENSEN MANAGEMENT TRUSTEE 1.0 0.0 X 0 0 0 PENNY SCHUMACHER MANAGEMENT TRUSTEE 1.0 0.0 X 0 0 0 0 0 0 0 false false false HMA INC 1440 KAPIOLANI BLVD HONOLULU HI 96814 CLAIMS ADMINISTRATOR 444098 HAWAII BENEFIT ADMINISTRATORS INC 200 N VINEYARD BLVD STE 100 HONOLULU HI 96817 THIRD PARTY ADMIN. 214259 2 0 EMPLOYER CONTRIBUTIONS 900099 20028128 20028128 SELF PAY & COBRA CONTRIBUTIONS 900099 456462 456462 20484590 82022 82022 0 0 0 0 0 3869200 3874106 -4906 -4906 -4906 0 0 0 0 0 0 0 0 0 0 20561706 20484590 77116 0 0 0 14956018 0 0 0 0 0 0 214259 46882 46230 0 0 17956 78534 0 61362 5272 0 0 0 0 0 0 0 0 7304 MEDICAL CLAIMS ADMIN. 444098 DENTAL CLAIMS ADMIN. 62179 BANK FEES 3399 MEMBER SERVICE REIMBURSEMENTS 45905 1063 15990461 19594 -87163 5760665 8286370 0 0 2152427 1991659 0 0 0 0 0 0 0 0 0 0 0 0 3075756 4650767 0 0 0 0 0 0 506547 519211 11514989 15360844 59852 59297 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4328216 3677464 4388068 3736761 X 0 0 0 0 7126921 11624083 7126921 11624083 11514989 15360844 X 4571245 -74083 X X false true X true 0 BENEFIT OBLIGATIONS 3677464 3677464 X 20487623 -74083 -74083 20561706 20561706 15990461 15990461 15990461 PART X, LINE 2: THE PLAN HAS ADOPTED GUIDANCE ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES ISSUED BY THE FINANCIAL ACCOUNTING STANDARDS BOARD. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE PLAN AND RECOGNIZE A TAX LIABILITY IF THE PLAN HAS TAKEN A TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY A TAX AUTHORITY. THE PLAN IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART I, LINE 1 AND PART III, LINES 1 AND 4A: THE PLAN IS DESIGNED TO PROVIDE BENEFITS FOR ELIGIBLE PARTICIPANTS OF THE PLAN, SUCH AS MEDICAL, DENTAL, PRESCRIPTION DRUGS, CHIROPRACTIC, VISION AND LIFE INSURANCE. PART VI, SECTION A, LINE 3: THE PLAN HAS DELEGATED MANAGEMENT DUTIES TO A THIRD PARTY ADMNINISTRATOR. PART VI, SECTION A, LINE 8B: THE PLAN DOES NOT HAVE COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. PART VI, SECTION B, LINE 11B: FORM 990 IS REVIEWED BY THE BOARD OF TRUSTEES AND PLAN ADMINISTRATOR AND APPROVED PRIOR TO FILING. PART VI, SECTION B, LINE 12C: THE TRUSTEES OF THE PLAN COMPLETE AND SIGN CONFLICT OF INTEREST FORMS ANNUALLY AT THEIR BOARD OF TRUSTEES MEETING. PART VI, SECTION B, LINE 15: MEMBERS OF THE GOVERNING BODY DO NOT RECEIVE COMPENSATION. PART VI, SECTION C, LINE 19: THE PLAN DOCUMENT AND ANY OTHER GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, INCLUDING THE FINANCIAL STATEMENTS ARE MAINTAINED AT THE PLAN ADMINISTRATOR'S OFFICE AND ARE AVAILABLE UPON WRITTEN REQUEST. ADDITIONALLY, COPIES OF FINANCIAL STATEMENTS ARE DISTRIBUTED TO THE TRUSTEES OF THE PLAN ON A REGULAR BASIS. PART VII, SECTION A: ANY TRUSTEES' COMPENSATION AND/OR BENEFITS FROM RELATED TAX-EXEMPT ORGANIZATIONS IS AVAILABLE ON THOSE ORGANIZATIONS' FORM 990. PART XII, LINE 2C: THE BOARD OF TRUSTEES ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED. THIS INFORMATION IS AVAILABLE AT THE THIS INFO IS AVAILABLE AT THE THIS INFORMATION IS AVAILABLE AT THE false false false false false false false false false false false false false false false true false false false